Automated endoscope for optimal positioning

ABSTRACT

A robotic system that moves a surgical instrument in response to the actuation of a foot pedal that can be operated by the foot of a surgeon. The robotic system has an end effector that is adapted to hold a surgical instrument such as an endoscope. The end effector is coupled to a robotic arm assembly which can move the endoscope relative to the patient. The system includes a computer which controls the movement of the robotic arm in response to input signals received from the foot pedal.

This is a continuation of application Ser. No. 08/305,796, filed Sep. 13, 1994, now abandoned which is a continuation of application Ser. No. 08/005,604 filed Jan. 19, 1993, now abandoned which in turn is a continuation-in-part of application Ser. No. 07/927,801, filed Aug. 10, 1992, now abandoned.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to a robotic system for remotely controlling the position of a surgical instrument.

2. Description of Related Art

Endoscopes typically contain a lens that is coupled to a visual display by a fiber optic cable. Such a system allows the user to remotely view an image in front of the scope. Endoscopes are commonly used in a surgical procedure known as laparoscopy, which involves inserting the endoscope into the patient through a small incision in the abdomen. The endoscope allows the surgeon to internally view the patient without being in a direct line of sight with the object. The use of an endoscope typically reduces the size of the incision needed to perform a surgical procedure.

Endoscopes are commonly used to assist the surgeon in removing the gall bladder of a patient. Because the surgeon typically requires both hands to remove a gall bladder, the endoscope must be held and operated by a assistant. During the surgical procedure, the surgeon must frequently instruct the assistant to move the endoscope within the patient. Such a method can be time consuming as the surgeon may have to relay a series of instructions until the assistant has positioned the endoscope in the proper location.

Additionally, the assistant may be unable to consistently hold the instrument in a fixed position, resulting in a moving image. This is particularly true for surgical procedures that extend over a long period of time.

There is presently a system marketed by Leonard Medical Inc. which mechanically holds an endoscope. The Leonard Medical system is an articulated mechanism which has a plurality of pneumatically powered joints that hold the endoscope in a fixed position. To move the endoscope, the pneumatic powered joints must be initially released into a relaxed condition. The surgeon or assistant then moves the scope and reactivates the pneumatic system. Although the Leonard system holds the endoscope in one position, the system requires the surgeon or assistant to constantly deactivate/activate the pneumatics and manually move the scope. Such a system interrupts the surgery process and increases the time of the surgical procedure. It would be desirable to provide a system that allows the surgeon to directly and efficiently control the movement of an endoscope.

SUMMARY OF THE INVENTION

The present invention is a robotic system that moves a surgical instrument in response to the actuation of a foot pedal that can be operated by the foot of a surgeon. The robotic system has an end effector that is adapted to hold a surgical instrument such as an endoscope. The end effector is coupled to a robotic arm assembly which can move the endoscope relative to the patient. The system includes a computer which controls the movement of the robotic arm in response to input signals from the foot pedal.

The computer computes the amount of incremental movement required to move the end effector in accordance with a set of algorithms. The algorithms transform the input of the foot pedal so that the movement of the endoscope as seen by the surgeon is always in the same direction as the movement of the foot pedal. Thus when the foot pedal is depressed to move the endoscope up or down, the end effector is manipulated so that the scope always moves relative to the image in an up or down direction as viewed by the surgeon.

Therefore it is an object of the present invention to provide a system which allows a surgeon to remotely control the position of a surgical instrument.

BRIEF DESCRIPTION OF THE DRAWINGS

The objects and advantages of the present invention will become more readily apparent to those ordinarily skilled in the art after reviewing the following detailed description and accompanying drawings, wherein:

FIG. 1 is a side view of a robotic system of the present invention;

FIG. 2 is a top view of the robotic system of FIG. 1;

FIG. 3 is a top view of an end effector used to hold an endoscope;

FIG. 4 is a top view of a foot pedal of the system of FIG. 1;

FIG. 5 is a cross-sectional view of the foot pedal of FIG. 4;

FIG. 6 is a schematic of a computer of the robotic system shown in FIG. 1;

FIG. 7 is a schematic of the endoscope oriented in a second coordinate system;

FIG. 8 is a flowchart showing the operation of the system;

FIG. 9 is a graph showing the incremental movement of the robotic arm assembly;

FIG. 10 is a cross-sectional view of the robotic arm assembly showing actuators coupled to clutch and drive train assemblies;

FIG. 11 is a side view of the system showing a protective sterile bag which encapsulates the robotic arm assembly;

FIG. 12 is a cross-sectional view of an alternate embodiment of the end effector.

DETAILED DESCRIPTION OF THE INVENTION

Referring to the drawings more particularly by reference numbers, FIGS. 1 and 2 show a robotic system 10 of the present invention. The system 10 is typically used in a sterile operating room where a surgeon (not shown) performs a surgical procedure on a patient 12. The patient 12 is placed on a operating table 14. Attached to the table 14 is a robotic arm assembly 16 which can move a surgical instrument 18 relative to the table 14 and the patient 12. The surgical instrument 18 is typically an endoscope which is inserted into the abdomen of the patient 12. The endoscope 18 enters the patient through cannula, wherein the scope 18 rotate about a cannula pivot point. The endoscope is typically connected to a display screen (not shown) which allows the surgeon to view the organs, etc. of the patient. Although an endoscope is described and shown, it is to be understood that the present invention can be used with other surgical instruments.

The system 10 has a computer 20 that is connected to the robotic arm assembly 16 and a foot pedal 22. The foot pedal 22 is located in close proximity to the operating table 14, so that the surgeon can operate the foot pedal 22 while performing a surgical procedure. The system 10 is constructed so that the surgeon can move the surgical instrument 18 by merely depressing the foot pedal 22.

The robotic arm assembly 16 includes a linear actuator 24 fixed to the table 14. The linear actuator 24 is connected to a linkage arm assembly 26 and adapted to move the linkage assembly 26 along the z axis of a first coordinate system. As shown in FIG. 2, the first coordinate system also has an x axis and a y axis. The linear actuator 24 preferably has an electric motor which turns a ball screw that moves the output shaft of the actuator.

The linkage arm assembly 26 includes a first linkage arm 28 attached to a first rotary actuator 30 and an end effector 32. The first rotary actuator 30 is adapted to rotate the first linkage arm 28 and end effector 32 in a plane perpendicular to the z axis (x-y plane). The first rotary actuator 30 is connected to a second rotary actuator 34 by a second linkage arm 36. The second actuator 34 is adapted to rotate the first actuator 30 in the x-y plane. The second rotary actuator 34 is connected to a third rotary actuator 38 by a third linkage arm 40. The third rotary actuator 38 is connected to the output shaft of the linear actuator 24 and adapted to rotate the second rotary actuator 34 in the x-y plane. The rotary actuators are preferably electric motors with output shafts attached to the respective linkage arms. The actuators 30, 34 and 38 preferably have gear reduction boxes to increase the torque at the linkage arms relative to the electric motors. The electric motors of the actuators 24, 30, 34 and 38 rotate in response to output signals provided by the computer 20.

As shown in FIG. 3, the end effector 32 has a clamp 42 which can grasp and hold the endoscope 18. The clamp 42 may be constructed as a wire with a loop that has a diameter smaller than the outside diameter of the scope 18. The clamp 42 allows the scope to be easily attached to and removed from the robotic arm assembly 16. Although a simple wire clamp is shown and described, it is to be understood that the end effector 32 may have any means required to secure the surgical instrument 18. As shown in FIGS. 1 and 2, the junction of the endoscope 18 and the end effector 32 define a second coordinate system which has an x' axis, a y' axis and a z' axis. The junction of the end effector 32 and endoscope 18 also define the origin of a third coordinate system which has a x" axis, a y" axis and a z" axis that is parallel with the longitudinal axis of the endoscope 18.

The end effector 32 has a shaft 44 which can be coupled to the first linkage arm 28. The first linkage arm 28 may have a bearing which allows the end effector 32 to rotate about the longitudinal axis of the arm 28. The end effector 32 may be constructed so that the clamp 42 and scope 18 can rotate about the y' axis. The end effector 32 is preferably constructed to be detached from the first linkage arm 28, so that a sterile instrument can be used for each surgical procedure. The robotic system 10 may also have a bag or cover to encapsulate the robotic arm assembly 16 to keep the assembly 16 sterile.

The actuators 24, 30, 34 and 38 may each have position sensors 46-52 that are connected to the computer 20. The sensors may be potentiometers that can sense the rotational movement of the electric motors and provide feedback signals to the computer 20. The end effector 32 may also have a first joint position sensor 54 that senses the angular displacement of the effector about the x' axis and a second joint position sensor 55 which senses the angular displacement of the scope about the y' axis.

FIGS. 4 and 5 show a preferred embodiment of the foot pedal 22. The foot pedal 22 has a housing 56 that supports a first foot switch 58 and a second foot switch 60. The first foot switch 58 has a first pressure transducer 62 and a second pressure transducer 64. The second foot switch 60 has third 66, fourth 68, fifth 70 and sixth 72 pressure transducers. The transducers are each connected to a corresponding operational amplifier that provides a voltage input to the computer 20. The pressure transducers 62-72 are constructed so that the resistance of each transducer decreases as the surgeon increases the pressure on the foot switches. Such a transducer is sold by Interlink Electronics. The decreasing transducer resistance increases the input voltage provided to the computer 20 from the operational amplifier. Each transducer corresponds to a predetermined direction in the third coordinate system. In the preferred embodiment, the first pressure transducer 62 corresponds to moving the endoscope toward the image viewed by the surgeon. The second transducer 64 moves the scope away from the image. The third 66 and fourth 68 transducers move the scope 18 "up" and "down", respectively, and the fifth 70 and sixth 72 transducers move the scope 18 "left" and "right", respectively.

FIG. 6 shows a schematic of the computer 20. The computer 20 has a multiplexer 74 which is connected to the pressure transducers and the position sensors. In the preferred embodiment, the multiplexer 74 has 12 channels, one channel for each sensor and transducer. The multiplexer 74 is connected to a single analog to digital (A/D) converter 76.

The computer also has a processor 78 and memory 80. The A/D converter 76 is constructed so that the converter can provide the processor 78 with a binary string for each voltage level received from the input signals of the system. By way of example, the transducers may provide a voltage ranging between -10 to 10 volts (V) and the converter 76 may output a different 12 bit binary string for each voltage level. An input signal of 1.0 V may correspond to the binary string 000011001010, 2.0 V may correspond to 000111010100 and so forth and so on.

The processor 78 is connected to an address decoder 82 and four separate digital to analog (D/A) converters 84. Each D/A converter is connected to an actuator 26, 30, 34 or 38. The D/A converters 84 provide analog output signals to the actuators in response to output signals received from the processor 78. The analog output signals preferably have a sufficient voltage level to energize the electric motors and move the robotic arm assembly. The D/A converters 84 may be constructed so that a binary 1 from the processor produces an analog output signal that drives the motors. In such an embodiment, the motors are energized for as long as the processor provides a binary 1 output signal. The decoder 82 correlates the addresses provided by the processor with a corresponding D/A converter, so that the correct motor(s) is driven. The address decoder 82 also provides an address for the input data from the A/D converter so that the data is associated with the correct input channel.

The processor 78 computes the movement of the robotic arm assembly 16 in accordance with the following equations. ##EQU1## where;

a2=angle between the third linkage arm and the x axis.

a3=angle between the second linkage arm and the longitudinal axis of the third linkage arm.

a4=angle between the first linkage arm and the longitudinal axis of the second linkage arm.

L1=length of the third linkage arm.

L2=length of the second linkage arm.

L3=length of the first linkage arm.

π=the angle between the first linkage arm and the x' axis of the second coordinate system.

x=x coordinate of the end effector in the first coordinate system.

y=y coordinate of the end effector in the first coordinate system.

To move the end effector to a new location of the x-y plane the processor 78 computes the change in angles a2, a3 and a4, and then provides output signals to move the actuators accordingly. The original angular position of the end effector is provided to the processor 78 by the sensors 46-55. The processor moves the linkage arms an angle that corresponds to the difference between the new location and the original location of the end effector. A differential angle Δa2 corresponds to the amount of angular displacement provided by the third actuator 38, a differential angle Δa3 corresponds to the amount of angular displacement provided by the second actuator 34 and a differential angle Δa4 corresponds to the amount of angular displacement provided by the first actuator 30.

To improve the effectiveness of the system 10, the system is constructed so that the movement of the surgical instrument as seen by the surgeon, is always in the same direction as the movement of the foot pedal. Thus when the surgeon presses the foot switch to move the scope up, the scope always appears to move in the up direction. To accomplish this result, the processor 78 converts the desired movement of the end of the endoscope in the third coordinate system to coordinates in the second coordinate system, and then converts the coordinates of the second coordinate system into the coordinates of the first coordinate system.

The desired movement of the endoscope is converted from the third coordinate system to the second coordinate system by using the following transformation matrix; ##EQU2## where;

Δx"=the desired incremental movement of the scope along the x" axis of the third coordinate system.

Δy"=the desired incremental movement of the scope along the y" axis of the third coordinate system.

Δz" the desired incremental movement of the scope along the z" axis of the third coordinate system.

a5=the angle between the z' axis and the scope in the y'-z' plane.

a6 =the angle between the z' axis and the scope in the x'-z' plane.

Δx'=the computed incremental movement of the scope along the x' axis of the second coordinate system.

Δy'=the computed incremental movement of the scope along the y' axis of the second coordinate system.

Δz'=the computed incremental movement of the scope along the z' axis of the second coordinate system. The angles a5 and a6 are provided by the first 54 and second 55 joint position sensors located on the end effector 32. The angles a5 and a6 are shown in FIG. 7.

The desired movement of the endoscope is converted from the second coordinate system to the first coordinate system by using the following transformation matrix; ##EQU3## where;

Δx'=the computed incremental movement of the scope along the x' axis of the second coordinate system.

Δy'=the computed incremental movement of the scope along the y' axis of the second coordinate system.

Δz'=the computed incremental movement of the scope along the z' axis of the second coordinate system.

π=is the angle between the first linkage arm and the x axis of the first coordinate system.

Δx=the computed incremental movement of the scope along the x axis of the first coordinate system.

Δy=the computed incremental movement of the scope along the y axis of the first coordinate system.

Δz=the computed incremental movement of the scope along the z axis of the first coordinate system.

The incremental movements Δx and Δy are inserted into the algorithms (1) described above for computing the angular movements (Δa2, Δa3 and Δa4) of the robotic arm assembly to determine the amount of rotation that is to be provided by each electric motor. The value Δz is used to determine the amount of linear movement provided by the linear actuator 26.

After each movement of the endoscope a new π value must be computed to be used in the next incremental movement of the scope. The scope is typically always in the y'-z' plane, therefore the π value only changes when the end effector is moved along the y' axis. The new π angle can be computed with the following equations: ##EQU4## where;

d=the length of the endoscope between the end effector and the cannula pivot point.

r=the distance along the y' axis between the end effector and the cannula pivot point.

m=the incremental movement of the scope. The new π value is computed and stored in the memory of the computer for further computation.

FIG. 8 shows a flowchart of a program used to operate the system. The computer 20 initially computes the location of the end effector 32 with the input provided by the sensors 46-55. When the surgeon presses on one of the foot switches, the pedal provides a input signal to the computer. For example, the surgeon may want a closer look at an object in front of the endoscope. The surgeon then presses the top of the first foot switch, depressing the first transducer and providing an input signal to the computer. The input signal is converted into an 12 bit binary string which is received by the processor. The 12 bit string corresponds to a predetermined increment of Δz". The computer is constantly sampling the foot pedal, wherein each sample corresponds to a predetermined increment in the corresponding axis". If the surgeon holds down the foot pedal during two sampling periods then the increment to be moved is 2×Δz". The converter also provides a multiplication factor for each increase in voltage level received from the amplifier of the transducer, so that the increments are increased for each increase in voltage. Thus the surgeon can increase the amount of incremental movement by increasing the pressure on the foot switch.

The processor 78 then determines the new coordinates in the third coordinate system. The incremental movements in the third coordinate system (Δx", Δy" and Δz") are used to compute the increment movements in the second coordinate system (Δx', Δy' and Δz') and the coordinates in the first coordinate system (Δx, Δy and Δz). The incremental movements are then used to determine the change in the angles a2, a3 and a4, and the linear movement of actuator 24. The computer provides output signals to the appropriate electric motors to move the robotic arm assembly to the new position. The new π angle is computed and the process is repeated. The present invention thus allows the surgeon to remotely move a surgical instrument in a manner that directly correlates with the viewing image seen through the endoscope.

In the preferred embodiment, the system moves the end effector 32 so that the endoscope is always aligned in the same orientation relative to the patient. This is accomplished by moving the end effector so that the angle a6 is always equal to zero. Thus after each independent movement of the endoscope, the angle a6 is sensed by the sensor 55. If the angle a6 is not equal to zero, the processor moves the end effector in accordance with the following subroutine.

If a6>zero then the end effector is moved an increment equal to:

    Δπ=π+constant

If a6<zero then the end effector is moved an increment equal to:

    Δπ=π-constant

where;

Δπ=the incremental angular movement of the end effector.

    π=the preceding angle π.

constant=some predetermined incremental angular movement of the end effector.

The processor moves the end effector in accordance with the above described subroutine until the angle a6 is equal to zero. The new π angle is then stored and used for further computation. Maintaining the angle a6 at zero insures that the view seen by the surgeon is in the same orientation for all end effector positions.

As shown in FIG. 10, each linkage arm 28, 36 or 80 is preferably coupled to a first helical gear 92. The first helical gear 92 is mated with a second helical gear 94 that is coupled to an actuator 30, 34 or 38 by a clutch 96. The clutches 96 are preferably constructed from magnetic plates that are coupled together when power is supplied to the clutches. When power is terminated, the clutches 96 are disengaged and the actuators are decoupled from the drive shafts such that the linkage arms can be manually moved by the operator. Power is supplied to the clutches 96 through a switch 98 which can be operated by the surgeon. The clutches allow the surgeon to disengage the actuators and manually move the position of the endoscope.

As shown in FIG. 6, the system may have a lever actuated input device 100 that is commonly referred to as a "joystick". The input device 100 can be used in the same manner as the foot pedal, wherein the operator can move the endoscope by moving the lever 102 of the device 100. The device 100 may also have a plurality of memory buttons 104 that can be manipulated by the operator. The memory buttons 104 are coupled to the processor of the computer. The memory buttons 104 include save buttons 106 and recall buttons 108. When the save button 106 is depressed, the coordinates of the end effector in the first coordinate system are saved in a dedicated address(es) of the computer memory. When a recall button 108 is pushed, the processor retrieves the data stored in memory and moves the end effector to the coordinates of the effector when the save button was pushed.

The save memory buttons allow the operator to store the coordinates of the end effector in a first position, move the end effector to a second position and then return to the first position with the push of a button. By way of example, the surgeon may take a wide eye view of the patient from a predetermined location and store the coordinates of that location in memory. Subsequently, the surgeon may manipulate the endoscope to enter cavities, etc. which provide a more narrow view. The surgeon can rapidly move back to the wide eye view by merely depressing the recall button of the system. Additionally, the last position of the endoscope before the depression of the recall button can be stored so that the surgeon can again return to this position.

As shown in FIG. 9, the system is preferably moved during the recall cycle in a ramping fashion so that there is not any sudden movement of the linkage arm assembly. Instead of a purely linear movement of the actuators to move the end effector from point A to point B, the processor would preferably move the linkage arm assembly in accordance with the following equation.

    θ(t)=(1-t).sup.2 (θ.sub.0 +(2θ.sub.0 +θ.sub.0)t) +t.sup.2 (θ.sub.1 +(2θ.sub.1 +θ.sub.1)(1-t))

where;

t=time

θ_(o) =the initial position of the end effector.

θ₁ =the final position of the end effector.

θ₀ =the velocity of the end effector at position θ_(o).

θ₁ =the velocity of the end effector at position θ₁

By moving each actuator in accordance with the above described algorithm, the linkage arm assembly movement will gradually increase and then gradually decrease as the arm leaves and approaches the original and final positions, respectively. Moving the arm in accordance with the above described equation produces low initial and final arm acceleration values. The gradually increasing and decreasing movement of the arm prevents any abrupt or sudden movement of the arm assembly.

As shown in FIG. 11, the robotic arm assembly is preferably encapsulated by a bag 110. The bag 110 isolates the arm assembly 26 so that the arm does not contaminate the sterile field of the operating room. The bag 110 can be constructed from any material suitable to maintain the sterility of the room. The bag 110 may have fastening means such as a hook and loop material or a zipper which allows the bag to be periodically removed and replaced after each operating procedure.

FIG. 12 shows a preferred embodiment of an end effector 120. The end effector 120 has a magnet 122 which holds a metal collar 124 that is coupled to the endoscope 18. The collar 124 has a center aperture 126 which receives the endoscope 18 and a pair of arms 128 which together with screw 130 capture the scope 18. The collar 124 is constructed to fit within a channel 132 located in the end effector 120. The magnet 122 is typically strong enough to hold the endoscope during movement of the linkage arm, yet weak enough to allow the operator to pull the collar and scope away from the end effector.

While certain exemplary embodiments have been described and shown in the accompanying drawings, it is to be understood that such embodiments are merely illustrative of and not restrictive on the broad invention, and that this invention not be limited to the specific constructions and arrangements shown and described, since various other modifications may occur to those ordinarily skilled in the art. 

What is claimed is:
 1. A system that allows a user to control a movement of a surgical instrument that has a longitudinal axis and which is coupled to a display device that displays an object and maintains an orientation of the displayed object, comprising:movement means for holding and moving the surgical instrument, wherein an intersection of said movement means and the surgical instrument define an origin for a second coordinate system with respect to a first coordinate system, wherein the second coordinate system has a y-z plane; input means for inputting command signals from the user to move the surgical instrument; and, control means for receiving said command signals, computing an incremental movement of said movement means from said command signals and providing an output signal to said movement means to move the surgical instrument so that the longitudinal axis of the surgical instrument always remains in the y-z plane.
 2. The system as recited in claim 1, wherein said movement means includes a first linkage arm attached to attachment means and a first actuator which can rotate said first linkage arm and said attachment means in a plane perpendicular to a first z axis, said first actuator being coupled to a linear actuator which can translate said attachment means along an axis parallel with the first z axis.
 3. The system as recited in claim 2, wherein said control means includes first actuator sensor means coupled to said linear actuator for generating a first feedback signal which corresponds to a location of said first actuator on the first z axis, and second actuator sensor means coupled to said first actuator for generating a second feedback signal which corresponds to a location of said attachment means in the plane that is perpendicular to the first z axis.
 4. The system as recited in claim 2, wherein said movement means includes a second actuator attached to said first actuator by a second linkage arm, said second actuator being adapted to rotate said first actuator and said attachment means in the plane that is perpendicular to the first z axis.
 5. The system as recited in claim 4, wherein said control means includes third actuator sensor means coupled to said second actuator for generating a third feedback signal which corresponds to a location of said first actuator in the plane that is perpendicular to the first z axis.
 6. The system as recited in claim 4, wherein said movement means includes a third actuator connected to said linear actuator and attached to said second actuator by a third linkage arm, said third actuator being adapted to rotate said second actuator, said first actuator and said attachment means in the plane that is perpendicular to the first z axis.
 7. The system as recited in claim 6, wherein said control means includes fourth actuator sensor means coupled to said third actuator for generating a fourth feedback signal which corresponds to a location of said second actuator in the plane that is perpendicular to the first z axis.
 8. The system as recited in claim 2, wherein said attachment means has a first joint that allows the surgical instrument to rotate about a longitudinal axis of said first linkage arm and a second joint that allows the surgical instrument to rotate about an axis that is perpendicular to the longitudinal axis of said first linkage arm.
 9. The system as recited in claim 8, wherein said control means includes first joint sensor means coupled to said attachment means for generating a first joint feedback signal which corresponds to a first angular position of the surgical instrument relative to a second x axis, and second joint sensor means coupled to said attachment means for generating a second joint feedback signal which corresponds to a second angular position of the surgical instrument relative to the second y axis.
 10. The system as recited in claim 6, further comprising clutch means for disengaging said first actuator from said linear actuator, said second actuator from said first actuator and said third actuator from said second actuator when said clutch means receives a clutch input signal.
 11. The system as recited in claim 6, wherein said first, second and third actuators are electric motors.
 12. The system as recited in claim 1, wherein said control means is a computer which receives command signals from said input means and generates output signals to move the surgical instrument.
 13. The system as recited in claim 12, further comprising storage means for storing a first position of said end effector upon receiving a first storage input signal and moving said end effector to said first position upon receiving a second storage input signal.
 14. The system as recited in claim 1, wherein said input means is a foot pedal which can be pressed by the user to generate said command signals.
 15. The system as recited in claim 14, wherein said control means includes first actuator sensor means coupled to said linear actuator for generating a first feedback signal which corresponds to a location of said third actuator on the first z axis, second actuator sensor means coupled to said first actuator for generating a second feedback signal which corresponds to a location of said end effector in the plane that is perpendicular to the first z axis, third actuator sensor means coupled to said second actuator for generating a third feedback signal which corresponds to a location of said first actuator in the plane that is perpendicular to the first z axis, and fourth actuator sensor means coupled to said third actuator for generating a fourth feedback signal which corresponds to a location of said second actuator in the plane that is perpendicular to the first z axis.
 16. The system as recited in claim 15, wherein said control means includes first joint sensor means coupled to said end effector for generating a first joint feedback signal which corresponds to a first angular position of the surgical instrument relative to a second x axis, and second joint sensor means coupled to said end effector for generating a second joint feedback signal which corresponds to a second angular position of the surgical instrument relative to the second y axis.
 17. The system as recited in claim 16, further comprising storage means for storing a first position of said end effector upon receiving a first storage input signal and moving said end effector to said first position upon receiving a second storage input signal.
 18. The system as recited in claim 1, wherein said movement means includesa collar adapted to be attached to the surgical instrument and an end effector which has a magnet that is attracted to said collar and couples the surgical instrument to said end effector.
 19. The system as recited in claim 1, wherein said movement means includesa bag that encapsulates a robotic arm assembly.
 20. A system that allows a user to control a movement of a surgical instrument that has a longitudinal axis and which is coupled to a display device that displays an object and maintains an orientation of the object, comprising:a first linkage arm having a longitudinal axis; an end effector attached to said first linkage arm and adapted to hold the surgical instrument, said end effector having a first joint that allows the surgical instrument to rotate about the longitudinal axis of said first linkage arm, said end effector further having a second joint that allows the surgical instrument to rotate about an axis that is perpendicular to the longitudinal axis of said first linkage arm, wherein an intersection of said end effector and the surgical instrument define an origin for a second coordinate system with respect to a first coordinate system, wherein the second coordinate has a y-z plane; a first actuator connected to said first linkage arm such that said first actuator can rotate said first linkage arm in a plane perpendicular to a first z axis; a second linkage arm connected to said first actuator; a second actuator connected to said second linkage arm such that said second actuator can rotate said second linkage arm in the plane perpendicular to the first z axis; a third linkage arm connected to said second actuator; a third actuator connected to said third linkage arm such that said third actuator can rotate said third linkage arm in the plane perpendicular to the first z axis; a linear actuator attached to said table and said third actuator such that said linear actuator can translate said third actuator along the first z axis; a foot pedal that generates a command signal when depressed by the user to move the surgical instrument; and, control means for receiving said command signals computing an incremental movement of said first, second, third and linear actuators from said command signals and providing a plurality of output signals to said first, second, third and linear actuators to move the surgical instrument so that the longitudinal axis of the surgical instrument always remains in the y-z plane.
 21. The system as recited in claim 20, further comprising clutch means for disengaging said first actuator from said linear actuator, said second actuator from said first actuator and said third actuator from said second actuator when said clutch means receives a clutch input signal.
 22. A method for moving a surgical instrument relative to a patient, wherein the surgical instrument has a longitudinal axis, and is coupled to a display device that displays an object, comprising the steps of:a) attaching the surgical instrument to an end effector of a robotic arm assembly located within a first coordinate system having a first x axis, a first y axis, a first z axis, said robotic arm assembly being adapted to move said end effector relative to the patient in response to an input command from the user, said end effector and the surgical instrument having an intersection which defines a second coordinate system having a second x axis, a second y axis a second z axis and a y-z plane; b) inserting the surgical instrument into the patient, wherein the end of the surgical instrument is located within a third coordinate system having a third x axis, a third y axis and third z axis, wherein said third z axis is parallel with the longitudinal axis of the surgical instrument; c) inputting a command to move the end of the surgical instrument an incremental distance in the third coordinate system; d) computing an incremental moving distance of said end effector in the second coordinate system from the incremental distance of the end of the surgical instrument in the third coordinate system; e) computing an incremental moving distance of said end effector within the first coordinate system from the incremental moving distance of said end effector in the second coordinate system; f) moving said robotic arm assembly until said end effector has moved the computed incremental movement in the first coordinate system; and, g) moving said robotic arm assembly and the surgical instrument so that the third z axis always remains in the y-z plane.
 23. The method as recited in claim 22, wherein said incremental movement of said end effector in said second coordinate system is computed in accordance with the following transformation matrix: ##EQU5## wherein; Δx"=an incremental movement of the end of the surgical instrument along the third x axis;Δy"=an incremental movement of the end of the surgical instrument along the third y axis; Δz"=an incremental movement of the end of the surgical instrument along the third z axis; a5=an angle between the second z axis and the surgical instrument in a y-z plane of the second coordinate system; a6=an angle between the second z axis and the surgical instrument in a x-z plane of the second coordinate system; Δx'=a computed incremental movement of said end effector along the second x axis; Δy'=a computed incremental movement of said end effector along the second y axis; Δz'=a computed incremental movement of said end effector along the second z axis.
 24. The method as recited in claim 23, wherein said incremental movement of said end effector in said first coordinate system is computed in accordance with the following transformation matrix: ##EQU6## wherein; Δx=a computed incremental movement of said end effector along the first x axis;Δy=a computed incremental movement of said end effector along the first y axis; Δz=a computed incremental movement of said end effector along the first z axis; π=a angle between said end effector and the first x axis.
 25. The method as recited in claim 24, further comprising the steps of determining the angle a6 after said end effector is moved, and moving said robotic arm assembly in accordance with the following subroutine:If a6>zero then said end effector is moved an increment equal to:

    Δπ=π+constant

If a6<zero then said end effector is moved an increment equal to:

    Δπ=π-constant

where; Δπ=the incremental amount of angular movement of said end effector; π=a preceding angle π; constant=some predetermined incremental angular movement of said end effector;until the angle a6 is approximately equal to zero.
 26. The method as recited in claim 22, wherein said end effector is moved in said first coordinate system in accordance with the following equation:

    θ(t)=(1-t).sup.2 (θ.sub.0 +(2θ.sub.0 +θ.sub.0) t) +t.sup.2 (θ.sub.1 +(2θ.sub.1 30 θ.sub.1) (1-t)

where; t=time; θ₀ =an initial position of said end effector; θ₁ =a final position of said end effector; θ₀ =a velocity of said end effector at position θ₀ ; θ₁ =a velocity of said end effector at position θ₁.
 27. A method for moving a surgical instrument relative to a patient, wherein the surgical instrument has a longitudinal axis, and is coupled to a display device that displays an object, comprising the steps of:a) attaching the surgical instrument to an end effector of a robotic arm assembly located within a first coordinate system having a first x axis, a first y axis, a first z axis, said end effector and the surgical instrument having an intersection which defines a second coordinate system having a second x axis, a second y axis and a second z axis, said robotic arm assembly having a first actuator coupled to said end effector by a first linkage arm, a second actuator coupled to said first actuator by a second linkage arm and a third actuator coupled to said second actuator by a third linkage arm, said actuators being adapted to move said end effector in a plane perpendicular to the first z axis, said robotic assembly further having a linear actuator coupled to said third actuator to move said third actuator along the first z axis and a y-z plane; b) inserting the surgical instrument into the patient, wherein the end of the surgical instrument is located within a third coordinate system having a third x axis, a third y axis and third z axis wherein said third z axis is parallel with the longitudinal axis of the surgical instrument; c) inputting a command to move the end of the surgical instrument an incremental distance in the third coordinate system; d) computing an incremental moving distance of said end effector within the second coordinate system from the incremental distance of the end of the surgical instrument in the third coordinate system; e) computing an incremental moving distance of said end effector within the first coordinate system from the incremental moving distance of said end effector in the second coordinate system; f) moving said robotic arm assembly until said end effector has moved the incremental movement in the first coordinate system; and, g) moving said robotic arm assembly and the surgical instrument so that the third z axis always remains in the y-z plane.
 28. The method as recited in claim 27, wherein said incremental movements of said end effector in said second coordinate system is computed in accordance with the following transformation matrix: ##EQU7## wherein Δx"=an incremental movement of the end of the surgical instrument along the third x axis;Δy"=an incremental movement of the end of the surgical instrument along the third y axis; Δz"=an incremental movement of the end of the surgical instrument along the third z axis; a5=an angle between the second z axis and the surgical instrument in a y-z plane of the second coordinate system; a6=an angle between the second z axis and the surgical instrument in a x-z plane of the second coordinate system; Δx'=a computed incremental movement of said end effector along the second x axis; Δy'=a computed incremental movement of said end effector along the second y axis; Δz'=a computed incremental movement of said end effector along the second z axis.
 29. The method as recited in claim 28, wherein said incremental movement of said end effector in the first coordinate system is computed in accordance with the following information matrix: ##EQU8## wherein; Δx=a computed incremental movement of said end effector along the first x axis.Δy=a computed incremental movement of said end effector along the first y axis. Δz=a computed incremental movement of said end effector along the first z axis. π=an angle between said end effector and the first x axis.
 30. The method as recited in claim 29, wherein said linear actuator translates said third actuator ΔZ, said third actuator rotates said third linkage arm an angle of Δa2, wherein a2 is computed by the equations; ##EQU9## said second actuator rotates said second linkage arm an angle Δa3 wherein Δa3 is computed by the equation; ##EQU10## wherein; L1=is the length of said third linkage arm;L2=is the length of said second linkage arm; L3=is the length of said third first arm;and said first actuator rotates said first linkage arm an angle Δa4 wherein Δa4 is computed by the equation:

    Δa4=π-Δa2-Δa3.


31. The method as recited in claim 30, further comprising the steps of determining the angle a6 after said end effector is moved, and moving said robotic arm assembly in accordance with the following subroutine:If a6>zero then said end effector is moved an increment equal to:

    Δπ=π+constant

If a6<zero then said end effector is moved an increment equal to:

    Δπ=π-constant

where; Δπ=the incremental amount of angular movement of said end effector; π=a preceding angle π; constant=some predetermined incremental angular movement of said end effector;until the angle a6 is approximately equal to zero.
 32. The method as recited in claim 31, wherein said end effector is moved in accordance with the following equation:

    θ(t)=(1-t).sup.2 (θ.sub.0 +(2θ.sub.0 +θ.sub.0)t)+t.sup.2 (θ.sub.1 +(2θ.sub.1 +θ.sub.1)(1-t))

where; t=time; θ₀ =an initial position of said end effector; θ₁ =a final position of said end effector; θ₀ =a velocity of said end effector at position θ₀ ; θ₁ =a velocity of said end effector at position θ₁.
 33. A system that allows a user to control a movement of a surgical instrument that has a longitudinal axis and which is coupled to a display device that displays an object and maintains an orientation of the displayed object, comprising:a mechanism that holds and moves the surgical instrument, wherein an intersection of said mechanism and the surgical instrument defines an origin for a second coordinate system with respect to a first system, wherein the second coordinate system has a y-z plane; an input device that inputs command signals from the user to move the surgical instrument; and, a controller that receives said command signals, computes an incremental movement of said mechanism from said command signals and provides an output signal to said mechanism to move the surgical instrument so that the longitudinal axis of the surgical instrument is always remains in the y-z plane.
 34. The system as recited in claim 33, wherein said mechanism includes a first linkage arm attached to an end effector and a first actuator which can rotate said first linkage arm and said end effector in a plane perpendicular to a first z axis, said first actuator being coupled to a liner actuator which can translate said end effector along an axis parallel with the first z axis.
 35. The system as recited in claim 34, wherein said mechanism includes a first actuator sensor coupled to said linear actuator and which generates a first feedback signal which corresponds to a location of said first actuator on the first z axis, and a second actuator sensor coupled to said first actuator and which generates a second feedback signal which corresponds to a location of said end effector in the plane that is perpendicular to the first z axis.
 36. The system as recited in claim 34, wherein said mechanism includes a second actuator attached to said first actuator by a second linkage arm, said second actuator being adapted to rotate said first actuator and said end effector in the plane that is perpendicular to the first z axis.
 37. The system as recited in claim 36, wherein said mechanism includes a third actuator sensor coupled to said second actuator and which generates a third feedback signal which corresponds to a location of said first actuator in the plane that is perpendicular to the first z axis.
 38. The system as recited in claim 36, wherein said mechanism includes a third actuator connected to said linear actuator and attached to said second actuator by a third linkage arm, said third actuator being adapted to rotate said second actuator, said first actuator and said end effector in the plane that is perpendicular to the first z axis.
 39. The system as recited in claim 38, wherein said mechanism includes a fourth actuator sensor coupled to said third actuator and which generates a fourth feedback signal which corresponds to a location of said second actuator in the plane that is perpendicular to the first z axis.
 40. The system as recited in claim 38, further comprising a plurality of clutches that disengage said first actuator from said linear actuator, said second actuator from said first actuator and said third actuator from said second actuator when said clutches receives a clutch input signal.
 41. The system as recited in claim 38, wherein said first, second and third actuators are electric motors.
 42. The system as recited in claim 34, wherein said end effector has a first joint that allows the surgical instrument to rotate about a longitudinal axis of said first linkage arm and a second joint that allows the surgical instrument to rotate about an axis that is perpendicular to the longitudinal axis of said first linkage arm.
 43. The system as recited in claim 40, wherein said mechanism includes a first joint sensor which generates a first joint feedback signal which corresponds to a first angular position of the surgical instrument relative to a second x axis, and a second joint sensor coupled which generates a second joint feedback signal which corresponds to a second angular position of the surgical instrument relative to the second y axis.
 44. The system as recited in claim 33, wherein said controller is a computer which receives command signals from said input device and generates output signals to move the surgical instrument.
 45. The system as recited in claim 44, wherein said controller has memory that stores a first position of said end effector upon receiving a first storage input signal and moves said end effector to said first position upon receiving a second storage input signal.
 46. The system as recited in claim 33, wherein said input device is a foot pedal which can be pressed by the user to generate said command signals.
 47. The system as recited in claim 33, wherein said mechanism includes a collar attached to the surgical instrument and an end effector which has a magnet that is attracted to said collar and couples the surgical instrument to said end effector.
 48. The system as recited in claim 33, wherein said mechanism includes a bag that encapsulates a robotic arm. 